Retrospective Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2014; 20(22): 6953-6960
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6953
Liver regeneration after liver resection: Clinical aspects and correlation with infective complications
Duilio Pagano, Marco Spada, Vishal Parikh, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria
Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy
Marco Spada, Davide Cintorino, Bruno Gridelli, Salvatore Gruttadauria, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Paolo Grossi, Infectious Diseases Section, Department of Surgical and Morphological Sciences, University of Insubria, 21100 Varese, Italy
Vishal Parikh, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, United States
Author contributions: Gruttadauria S drafted the article critically for important intellectual content; Pagano D, Spada M, Tuzzolino F, Cintorino D, Maruzzelli L, Vizzini G, Luca A, Mularoni A, Grossi P, Gridelli B and Parikh V gave substantial contributions to concept and design, acquisition of data, and interpretation of data; Gruttadauria S, Spada M and Gridelli B gave the final approval of the version to be published.
Correspondence to: Salvatore Gruttadauria, MD, Associate Professor of Surgery, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, Via E. Tricomi, 1, 90127 Palermo, Italy. sgruttadauria@ismett.edu
Telephone: +39-91-2192111 Fax: +39-91-2192400
Received: November 5, 2013
Revised: February 13, 2014
Accepted: March 12, 2014
Published online: June 14, 2014
Abstract

AIM: To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.

METHODS: A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010. Regeneration was evaluated by multidetector computed tomography at a mean follow-up of 43.85 d. The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation, and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data. Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.

RESULTS: Ten of the 27 patients (37%) underwent chemotherapy prior to surgery, with a statistically significant prevalence of patients with metastasis (P = 0.007). Eight patients (30%) underwent embolization, 3 with primary tumors, and 5 with secondary tumors. Twenty patients (74%) experienced complications, with 12 (60%) experiencing Clavien-Dindo Grade 3a to 5 complications. Regeneration ≥ 100% occurred in 10 (37%) patients. The predictors were smaller future remnant liver volume (-0.002; P < 0.001), and a greater spleen volume/future remnant liver volume ratio (0.499; P = 0.01). Patients with a resection of ≥ 5 Couinaud segments experienced greater early regeneration (P = 0.04). Nine patients experienced surgical site infections, and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected (P = 0.016). There were no significant differences between patients with primary or secondary tumors, and either onset or infections or severity of surgical complications.

CONCLUSION: Regardless of the onset of infective complications, future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.

Keywords: Liver regeneration, Liver resection, Liver tumor

Core tip: Our study of 27 patients who underwent hepatectomies focuses on early liver regeneration after resection in patients with hepatic tumors but no underlying liver disease and on determining if post-operative infective complications might influence it. We identify three predictive factors for optimal early regeneration.